Ross Douthat on the personal and the political

Today, we are less divided over race, but more divided over sex and reproduction. In a country that cannot agree whether fetuses are human beings, even questions like how to mourn and bury a miscarried child are inevitably freighted with ideological significance. Likewise, in a country where the majority of Down syndrome fetuses are aborted, the mere act of carrying a child with a genetic disorder to term â€” as both the Palins and the Santorums, whose daughter Bella has Trisomy 18, have done â€” feels like a political statementâ€¦.

When Palin wove special needs children into her 2008 speeches, or when Santorum featured his daughter Bella in a campaign video, they were implicitly acknowledging these personal-is-political realities.

Iâ€™m sure that some parents regard this as a political statement. It is, unavoidably, a personal and moral one, too. And, yes, liberals should give the Santorum family greater space to mourn in accordance with their own beliefs. Yet thereâ€™s an underlying assumption in Douthatâ€™s passage that bears demands greater scrutiny.

Some social conservatives assert that liberals look down on or disapprove of parents who choose to carry a fetus to term after receiving unfavorable prenatal genetic test results. Others assert that a pro-choice perspective brings an accompanying callous attitude towards the disabled. This was, for example, an undertone in the discussion of Governor Palinâ€™s pregnancy during the 2008 campaign.

I know of no evidence for either assertion. I was very involved with the Obama campaign in 2008. All of us were pretty or very partisan Democrats. Many of us came to deeply oppose Governor Palin as the campaign progressed. None of us had any interest in attacking Governor Palin over her family issues or her pregnancy. That just wasnâ€™t what the campaign was about. A surprising number of us were caregivers for relatives and friends living with genetic disorders or other disabilities. Core to the pro-choice position isâ€”and certainly should beâ€”profound respect for parents who choose to continue a pregnancy knowing that this choice may bring particularly challenging implications and responsibilities.

My reading of the polling data is that peopleâ€™s attitudes regarding abortion are not correlated with peopleâ€™s willingness to provide practical help to people living with disabilities, or with peopleâ€™s attitudes towards families such as the Palins or the Santorums who have faced adversity or tragedy connected with genetic disorders. The poisonous terms of the culture wars have been mercifully absent in the world of disabilities.

Many of us on the left also believe that our preferred policy choicesâ€”universal health coverage, expanded educational services, expanded services and legal protections for the disabled, for exampleâ€”are especially important to protect and nurture children who are born with conditions that prevent their bodies or their minds from properly working as they are supposed to do.

I have no problem with conservative politicians such as Santorum showing moving pictures of their own children. Thereâ€™s a responsibility that comes with that. These same politicians should consider whatâ€™s happening around the country today as statesâ€”especially red onesâ€”curb optional Medicaid and intellectual disability services in response to both a deep recession and congressionally-mandated budget cuts.

Douthat at times writes beautifully about these issues from what might rightly be calledÂ a “compassionate Catholic” perspective. Yet many of the moralizing politicians he admires are failing to step up. As someone once said, â€œWhatever you neglected to do unto one of these least of these, you neglected to do unto Me.â€

Okay, but the source of the claim cited in the Wikipedia article doesn’t quite say that:

The aims of this systematic literature review are to estimate termination rates after prenatal diagnosis of one of five conditions: Down syndrome, spina bifida, anencephaly, and Turner and Klinefelter syndromes, and to determine the extent to which rates vary across conditions and with year of publication.

The missing link to get to Douthat’s claim is to determine what percentage of mothers never obtain a prenatal diagnosis and end up giving birth to a baby with Down syndrome. But I wouldn’t be surprised if it was greater than 50%, given the high percentages given in Mansfield, Hopfer, and Marteau.

Down’s syndrome has well-known risk factors, and the technology for diagnosing it in utero has been around for a long time. I know this is just another anecdote, but it comes from someone who spends a lot of time hanging around OB/GYNs and Labor and Delivery nurses: I would be not just surprised but astounded if you could produce statistics showing a significant fraction of pregnancies in women over 35 going to term without a test for Down’s.

I think the claim that the majority of Down’s fetuses are aborted is highly credible, and I have no sympathy whatever for Douthat’s overall position, and not much respect for what passes for moral reasoning in his writings.

Note: I believe that these studies calculate the abortion rate as a % of (prenatal) diagnosed cases. So the actual abortion rate for Down Syndrome fetuses is likely below these numbers. But given the fact that Down Syndrome is diagnosed before birth in the majority of cases (most cases occur with “at risk,” generally older, mothers and such mothers are tested as a matter of course), the 91-93% found in these studies almost certainly translates to Douthat’s “majority” statement. In fact, he is likely downplaying the extent to which fetuses with Down Syndrome are terminated.

Note also that these rates are very consistent with rates measured in Western Europe by researchers there.

There is a thin line between the public discussion by a politician of his or her personal experience with family members with disabilities and the exploitation of these experiences for political gain. I don’t get the sense that Santorum deliberately exploits this, but many of us certainly felt strongly that Palin was exploitative and, in fact, pushed her kids into the public spotlight for personal political ambition.

The persistent Republican assertion that liberals and Democrats disdain or look down upon families that choose to bring disabled children to full term is part of the larger phenomenon of Republicans treating their political opponents as evil and unpatriotic and as part of a conspiracy to impose some sort of one-world authoritarian government on the U.S. The GOP seems to be unable to see its political opposition for what it really is.

The lightning rod for inquiry into Senator Santorum’s views on sexuality is his willingness to lambaste those whose views and practices differ from those that Santorum and the old German in the pointy hat approve. The apostle whom the Roman Chickenhawk Church claims as its first pope listed busybodies alongside murderers, thieves and evildoers. (I Peter 4:15, KJV)

Senator Santorum was a leading advocate of making the procedure which critics call “partial birth abortion” a federal crime. He thereby placed at issue whether his conduct, along with that of his wife, when they were faced with a life-threatening pregnancy, is different in kind from what the Congress criminalized at Santorum’s behest. Or is Santorum’s position that abortion is morally wrong and should be criminalized for everyone whose first name is not Karen or whose last name is not Santorum?

Neither, on the other hand, should these people be held up as paragons of moral virtue on account of their willingness to bring disabled, possibly profoundly disabled, fetuses to term. And while this decision is theirs to make, and may be done with a good heart, I don’t think it’s out of bounds to question its wisdom. Love isn’t really an infinite resource; the time and attention — at some point, in a real sense, the love — that other children in a family get is liable to be substantially impacted by such a choice.

Not just time and attention, but also — especially in the world Santorum and his ilk are trying to create — money. Even where it’s available, insurance or government-subsidized care doesn’t cover nearly the full expense of taking care of a disabled infant/child/teen/adult. So the other kids in the family are saying goodbye to everything from fancy holiday presents and vacation trips to help with their college educations. You don’t have to look too far into the past to see the time when having someone disabled in the household meant one of the other offspring permanently drafted as caregiver.

Okay, agreed. But we also agree that “other children in a family” get “substantially impacted” by all sorts of decisions parents make. Yes? And perhaps we also agree that “wisdom” is not the sole, or even the primary factor to consider in such situations?

Harold, Ross has been pretty well shown to be full of it on a regular basis (for a start, go to Balloon Juice, and follow links from their take-downs). At this point, Ross should be assumed to be BSing unless contrary evidence arises.

This is the view that the different views of others are actually an attack on one’s own views: acceptance of gay marriage is an attack on heterosexual marriage, acceptance of Atheism is an attack on religion, opposition to war is unpatriotic, etc. Typical authoritarian paranoia.

My biggest problem with Douthat’s column is how he handwaves away the fact that Santorum’s wife induced labor to save her life in a manner sure to kill the fetus. He says that’s nothing like abortion because the Catholic doctrine of double effect says it’s OK to commit homicide as long as you pretend you don’t intend to kill.

In addition to this being a silly and morally offensive doctrine, he also ignores that the abortion restrictions he and Santorum favor would hang over any attempt to stop a pregnancy to save a woman’s life like a sword of Damocles, with prison time looming if a judge and jury disagrees with the doctor’s medical judgment.

Pro-lifers scorn health exceptions as loopholes that will allow abortion on demand. But without them, Karen Santorum may well not be able to receive her procedure.

Yeah, but (1) pro-lifers want to write into abortion statutes a very narrow “life of the mother” exception which would presumably override any broader common law defense, (2) given abortion is a medical procedure, we don’t want doctors worrying about a razor’s edge calculus as to whether they could face prosecution before performing a medically necessary abortion, and (3) Douthat doesn’t make that argument anyway; he says Santorum is specifically not a hypocrite because he is a Catholic and Catholics are permitted to have abortions as long as the doctor and patient pretend that they don’t intend to kill the fetus and are solely acting with some other intent instead.

“Today, we are less divided over race, but more divided over sex and reproduction…”. Nope. Not even close. A minority of you are clamoring for the rest of us to do as you say while we ignore your self-righteous intrusion into our lives and liberty. Your obsession with the sex and reproductive preferences of others is unseemly, or hadn’t you noticed?

Keep cutting and de-funding those social support programs and wage your religious wars to show your true reverence for life. Idiots.